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Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary?
Acad Radiol. 2019 07; 26(7):909-914.AR

Abstract

RATIONALE AND OBJECTIVES

There is lack of consensus on managing papillomas due to varied upgrade rates in the literature related to variability in the studied populations. We specifically studied upgrade rates of pure papilloma diagnosed with ultrasound core biopsy (UCB) using spring-loaded (SLB) and vacuum-assisted (VAB) biopsy devices in patients with low-to-intermediate pre-test probability for malignancy on imaging.

MATERIALS & METHODS

From 01/01/2008 to 06/30/2016, 227 patients with 248 pure papillomas classified as BI-RADS 3, 4a, and 4b were diagnosed by UCB and underwent surgical excision or clinical and/or imaging follow-up. Imaging features, biopsy device, and final pathology were documented.

RESULTS

177 lesions were biopsied with SLB (14-gauge) and 71 lesions with VAB (9-13 gauges). At surgery, upgrade rates to high-risk lesions and malignancy for SLB were 14.3% (22/154) and 1.9% (3/154), and for VAB were 3.5% (2/57) and 0% (0/57), respectively (p < 0.05). The combined surgical upgrade rate to high-risk lesions and malignancy was 11.4% (24/211) and 1.4% (3/211), respectively. The overall upgrade rate (including surgical and clinical and/or imaging follow-up) to high-risk lesions and malignancy was 9.7% (24/248) and 1.2% (3/248), respectively. No ultrasound features were predictive of upgrade. Rates of complete excision were 7.1% (11/154) for SLB and 19.3% (11/57) for VAB (p < 0.05).

CONCLUSION

BI-RADS 3, 4a, or 4b masses biopsied with UCB revealed pure papilloma upgrade to malignancy in less than 2% of cases. SLB was associated with greater upgrades compared with VAB. Therefore, follow-up imaging is a reasonable alternative to excision, particular in those sampled by VAB. Excision could be considered if the diagnosis of a high-risk lesion would change clinical management.

Authors+Show Affiliations

American Radiology Associates, Baylor University Medical Center, 712 N. Washington, Suite 101, Dallas, TX 75246. Electronic address: sean.raj@gmail.com.Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: jphilli2@bidmc.harvard.edu.Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: tmehta@bidmc.harvard.edu.Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: lmquina@bidmc.harvard.edu.Belkin Breast Imaging Center, Boston Medical Center, Moakley Building, 830 Harrison Avenue,1st Floor, Boston, MA 02118. Electronic address: Michael.fishman@bmc.org.Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: vdialani@bidmc.harvard.edu.Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Electronic address: pslanetz@bidmc.harvard.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30297308

Citation

Raj, Sean D., et al. "Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma By Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary?" Academic Radiology, vol. 26, no. 7, 2019, pp. 909-914.
Raj SD, Phillips J, Mehta TS, et al. Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary? Acad Radiol. 2019;26(7):909-914.
Raj, S. D., Phillips, J., Mehta, T. S., Quintana, L. M., Fishman, M. D., Dialani, V., & Slanetz, P. J. (2019). Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary? Academic Radiology, 26(7), 909-914. https://doi.org/10.1016/j.acra.2018.08.014
Raj SD, et al. Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma By Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary. Acad Radiol. 2019;26(7):909-914. PubMed PMID: 30297308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary? AU - Raj,Sean D, AU - Phillips,Jordana, AU - Mehta,Tejas S, AU - Quintana,Liza M, AU - Fishman,Michael D, AU - Dialani,Vandana, AU - Slanetz,Priscilla J, Y1 - 2018/10/06/ PY - 2018/05/14/received PY - 2018/08/21/revised PY - 2018/08/23/accepted PY - 2018/10/10/pubmed PY - 2020/5/7/medline PY - 2018/10/10/entrez KW - Papilloma KW - Ultrasound KW - Ultrasound guided core biopsy KW - Upgrade rates SP - 909 EP - 914 JF - Academic radiology JO - Acad Radiol VL - 26 IS - 7 N2 - RATIONALE AND OBJECTIVES: There is lack of consensus on managing papillomas due to varied upgrade rates in the literature related to variability in the studied populations. We specifically studied upgrade rates of pure papilloma diagnosed with ultrasound core biopsy (UCB) using spring-loaded (SLB) and vacuum-assisted (VAB) biopsy devices in patients with low-to-intermediate pre-test probability for malignancy on imaging. MATERIALS & METHODS: From 01/01/2008 to 06/30/2016, 227 patients with 248 pure papillomas classified as BI-RADS 3, 4a, and 4b were diagnosed by UCB and underwent surgical excision or clinical and/or imaging follow-up. Imaging features, biopsy device, and final pathology were documented. RESULTS: 177 lesions were biopsied with SLB (14-gauge) and 71 lesions with VAB (9-13 gauges). At surgery, upgrade rates to high-risk lesions and malignancy for SLB were 14.3% (22/154) and 1.9% (3/154), and for VAB were 3.5% (2/57) and 0% (0/57), respectively (p < 0.05). The combined surgical upgrade rate to high-risk lesions and malignancy was 11.4% (24/211) and 1.4% (3/211), respectively. The overall upgrade rate (including surgical and clinical and/or imaging follow-up) to high-risk lesions and malignancy was 9.7% (24/248) and 1.2% (3/248), respectively. No ultrasound features were predictive of upgrade. Rates of complete excision were 7.1% (11/154) for SLB and 19.3% (11/57) for VAB (p < 0.05). CONCLUSION: BI-RADS 3, 4a, or 4b masses biopsied with UCB revealed pure papilloma upgrade to malignancy in less than 2% of cases. SLB was associated with greater upgrades compared with VAB. Therefore, follow-up imaging is a reasonable alternative to excision, particular in those sampled by VAB. Excision could be considered if the diagnosis of a high-risk lesion would change clinical management. SN - 1878-4046 UR - https://www.unboundmedicine.com/medline/citation/30297308/Management_of_BIRADS_3_4A_and_4B_Lesions_Diagnosed_as_Pure_Papilloma_by_Ultrasound_Guided_Core_Needle_Biopsy:_Is_Surgical_Excision_Necessary L2 - https://linkinghub.elsevier.com/retrieve/pii/S1076-6332(18)30412-4 DB - PRIME DP - Unbound Medicine ER -